1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

According to the World Health Organization (WHO, 2014), at the end of 2012, 38% of healthcare facilities in 54 low-resource countries did not have a clean water source. There are 46 countries where at least half of the population is not using a clean water sanitation facility and 748 million people, 90% living in sub-Saharan Africa and Asia (43% in Sub-Saharan Africa, and 47% in Asia), still use unimproved drinking water sources (WHO). The acronym WASH is defined as improved water, sanitation, and hygiene and is seen as a group of less dramatic but essential interventions that may have an important impact on reducing maternal and child morbidity and mortality globally. One-half million babies die within the first month of life because of inadequate sanitation and lack of clean water. For example, newborns with a newly cut umbilical cord washed with contaminated water have a high risk of contracting neonatal tetanus or sepsis.


Benova, Cumming, Gordon, Magoma, and Campbell (2014) assessed the WATSAN (water and sanitation) environment during home and healthcare facility births in Tanzania and confirmed that lack of adequate water and appropriate sanitation during childbirth leads to compromised maternal and newborn outcomes. In low-resource countries globally, WASH interventions are making a tremendous difference in reducing maternal and child morbidity and mortality, including maternal education and water treatment such as boiling and the use of water filters. Provision of safe drinking water and health education about cholera in a village in south India has resulted in reduced mortality, overcoming such common practices as the lack of water purification, open-field defecation, and inadequate handwashing (Deepthi, Sandeep, Rajini, Rajeshwari, & Shetty, 2013). Prevalence of diarrhea in Burundi was lower in children 5 years of age and younger when mothers were educated about hygiene and treated household water by boiling (Diouf, Tabatabai, Rudolph, & Marx, 2014). Correct, consistent, and sustained use of household water filters obtained through microfinance institutions for women's self-help groups in rural India has been found to be helpful (Freeman, Trinies, Boisson, Mak, & Clasen, 2012).


A multipronged approach is needed in order to make a difference in low-resource countries with high disease burdens. The UNICEF WASH strategies for enhanced child survival and development include the provision of water supply and sanitation services, the promotion of behavioral changes, and water and sanitation services. WaterAid, an organization that works to improve access to safe water, hygiene, and toilets in the poorest parts of the world, is calling for significantly improved water and sanitation globally by 2030 (Velleman et al., 2014). They advocate for total access to WASH in all institutions and public spaces, including healthcare facilities. Without clean water and sanitation, the health of mothers and their children in poor-resource countries will remain at significant risk for adverse outcomes.




Benova L., Cumming O., Gordon B. A., Magoma M., Campbell O. M. (2014). Where there is no toilet: Water and sanitation environments of domestic and facility births in Tanzania. PLoS One, 9(9), e106738. doi:10.1371/journal.pone.0106738 [Context Link]


Deepthi R., Sandeep S. R., Rajini M., Rajeshwari H., Shetty A. (2013). Cholera outbreak in a village in south India: Timely action saved lives. Journal of Infections Public Health, 6(1), 35-40. doi:10.1016/j.jiph.2012.05.003 [Context Link]


Diouf K., Tabatabai P., Rudolph J., Marx M. (2014). Diarrhoea prevalence in children under five years of age in rural Burundi: An assessment of social and behavioural factors at the household level. Global Health Action, 7, 24895. doi:10.3402/gha.v7.24895 [Context Link]


Freeman M. C., Trinies V., Boisson S., Mak G., Clasen T. (2012). Promoting household water treatment through women's self help groups in rural India: Assessing impact on drinking water quality and equity. PLoS One, 7(9), e44068. doi:10.1371/journal.pone.0044068 [Context Link]


Velleman Y., Mason E., Graham W., Benova L., Chopra M., Campbell O. M., ..., Cumming O. (2014). From joint thinking to joint action: A call to action on improving water, sanitation, and hygiene for maternal and newborn health. PLoS Medicine, 11(12), e1001771. doi:10.1371/journal.pmed.1001771 [Context Link]


World Health Organization. (2014). Landmark report on the status of water, sanitation, and hygiene and environmental conditions in healthcare facilities. Geneva: Author. [Context Link]